The long range goal of this project is to define the role of psychosocial factors in determining phathogenesis and outcomes of coronary heart disease (CHD); and, ultimately, to apply such knowledge to the prevention, treatment and rehabilitation of CHD. During the next 3-year period primary efforts will focus on analysis of data already in hand on over 1500 patients who underwent coronary angiography at Duke and who will be followed indefinitely. Building on the work to date, three specific aims are proposed. 1) High scores on an MMPI "hostility"(Ho) scale correlate with coronary atherosclerosis (CAD) in our selected clinical sample, and they prospectively predict CHD events as well as total mortality in both a middle-aged and a young sample, each of which took the MMPI 25 years ago. We and one other group have now succeeded in factor analyzing the MMPI at the item level, and have both found similar reliable item clusters related to hostility which appear to have construct validity. We propose to evaluate these clusters as both correlates of CAD in our clinical sample and predictors of CHD and other health outcomes in the two prospective samples, as well as a new sample of 1000 naval submariners who took the MMPI 15 years ago when their mean age was 26. 2) Analysis of Functional Status Questionnaire data on over 1900 patients has enabled us to derive independent scales which appear to be reliable and valid measures of the following aspects of the quality of life: physical activity at work and elsewhere; sufficiency of financial resources; perceived adequacy of social support; and frequency of social contacts. We propose to use these scales both as baseline predictors and follow-up indices to evaluate the quality of life outcome in medically and surgically treated patients, and to see if just as with the angina outcome there are baseline physical and psychosocial predictors of the more broadly defined quality of life outcome. 3) Death and CHD events are now mounting in our sample since data collection began over 8 years ago. We propose to do further Cox model analyses to identify baseline psychosocial factors which predict CHD morbidity and mortality independently of potent physical predictors; also to see if angina relief over longer follow-ups and in patients on Ca++ blockers is predicted by psychosocial factors. Achievement of these of these aims will refine the definition of coronary prone behavior, increase knowledge regarding determinants of a wide variety of CHD outcomes and, ultimately; could lead to new knowledge which would improve approaches to the prevention, treatment and rehabilitation of CHD.